Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy

Ho, Allen L.; Sussman, Eric S; Pendharkar, Arjun V; Mantovani, Alessandra Madia; Keebaugh, Alaine C.; Drover, David R.; Grant, Gerald A.; Wintermark, Max; Halpern, Casey H.

doi:10.3171/2017.1.jns162046

Cited by 20 publications

(11 citation statements)

References 19 publications

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“…In 2 patients who required ablation of both the rostrum and splenium of the corpus callosum, we performed LITT entirely in the MRI suite using the ClearPoint platform (MRI Interventions). 13 Briefly, these patients were transported to the MRI suite for induction of general anesthesia. Next, they were positioned laterally with the right side up in the ClearPoint 4-point fixation head frame.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Stereotactic laser ablation for completion corpus callosotomy

Huang¹,

Yecies²,

Bruckert

et al. 2019

Journal of Neurosurgery: Pediatrics

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OBJECTIVECompletion corpus callosotomy can offer further remission from disabling seizures when a prior partial corpus callosotomy has failed and residual callosal tissue is identified on imaging. Traditional microsurgical approaches to section residual fibers carry risks associated with multiple craniotomies and the proximity to the medially oriented motor cortices. Laser interstitial thermal therapy (LITT) represents a minimally invasive approach for the ablation of residual fibers following a prior partial corpus callosotomy. Here, the authors report clinical outcomes of 6 patients undergoing LITT for completion corpus callosotomy and characterize the radiological effects of ablation.METHODSA retrospective clinical review was performed on a series of 6 patients who underwent LITT completion corpus callosotomy for medically intractable epilepsy at Stanford University Medical Center and Lucile Packard Children’s Hospital at Stanford between January 2015 and January 2018. Detailed structural and diffusion-weighted MR images were obtained prior to and at multiple time points after LITT. In 4 patients who underwent diffusion tensor imaging (DTI), streamline tractography was used to reconstruct and evaluate tract projections crossing the anterior (genu and rostrum) and posterior (splenium) parts of the corpus callosum. Multiple diffusion parameters were evaluated at baseline and at each follow-up.RESULTSThree pediatric (age 8–18 years) and 3 adult patients (age 30–40 years) who underwent completion corpus callosotomy by LITT were identified. Mean length of follow-up postoperatively was 21.2 (range 12–34) months. Two patients had residual splenium, rostrum, and genu of the corpus callosum, while 4 patients had residual splenium only. Postoperative complications included asymptomatic extension of ablation into the left thalamus and transient disconnection syndrome. Ablation of the targeted area was confirmed on immediate postoperative diffusion-weighted MRI in all patients. Engel class I–II outcomes were achieved in 3 adult patients, whereas all 3 pediatric patients had Engel class III–IV outcomes. Tractography in 2 adult and 2 pediatric patients revealed time-dependent reduction of fractional anisotropy after LITT.CONCLUSIONSLITT is a safe, minimally invasive approach for completion corpus callosotomy. Engel outcomes for completion corpus callosotomy by LITT were similar to reported outcomes of open completion callosotomy, with seizure reduction primarily observed in adult patients. Serial DTI can be used to assess the presence of tract projections over time but does not classify treatment responders or nonresponders.

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Section: Surgical Proceduresmentioning

confidence: 99%

Stereotactic laser ablation for completion corpus callosotomy

Huang¹,

Yecies²,

Bruckert

et al. 2019

Journal of Neurosurgery: Pediatrics

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“…This series of procedures is possible through local anesthesia and light sedation, although most centers perform this procedure under general anesthesia. Recently, some authors have reported experience on MRgLITT in epilepsy patients using the ClearPoint ® system (MRI Interventions, Inc., Irvine, CA, USA) that allows for the entire surgical procedure to be performed utilizing real-time MR guidance in the MR imaging suite by providing a frameless stereotactic platform [14,26,38]. This MR-guided frameless stereotactic platform is more time-efficient, reducing the mean anesthesia time by more than 100 minutes.…”

Section: Mr-guided Laser Ablation Systemmentioning

confidence: 99%

A Primer on Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Medically Refractory Epilepsy

Lee

Kalia

Hong

2019

J Korean Neurosurg Soc

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Epilepsy surgery that eliminates the epileptogenic focus or disconnects the epileptic network has the potential to significantly improve seizure control in patients with medically intractable epilepsy. Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) has been an established option for epilepsy surgery since the US Food and Drug Administration cleared the use of MRgLITT in neurosurgery in 2007. MRgLITT is an ablative stereotactic procedure utilizing heat that is converted from laser energy, and the temperature of the tissue is monitored in real-time by MR thermography. Real-time quantitative thermal monitoring enables titration of laser energy for cellular injury, and it also estimates the extent of tissue damage. MRgLITT is applicable for lesion ablation in cases that the epileptogenic foci are localized and/or deep-seated such as in the mesial temporal lobe epilepsy and hypothalamic hamartoma. Seizure-free outcomes after MRgLITT are comparable to those of open surgery in well-selected patients such as those with mesial temporal sclerosis. Particularly in patients with hypothalamic hamartoma. In addition, MRgLITT can also be applied to ablate multiple discrete lesions of focal cortical dysplasia and tuberous sclerosis complex without the need for multiple craniotomies, as well as disconnection surgery such as corpus callosotomy. Careful planning of the target, the optimal trajectory of the laser probe, and the appropriate parameters for energy delivery are paramount to improve the seizure outcome and to reduce the complication caused by the thermal damage to the surrounding critical structures.

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“…Alternatively, with recent advances, it is possible to perform the entire procedure within the MRI suite using a real-time MRI system, such as the ClearPoint platform, for neuronavigation. 6 The ClearPoint platform consists of a MRI-compatible percutaneous SMART-frame, a hand-held twist drill, ceramic stylet, and a trajectory guide tower. Use of the platform obviates the need for skull fiducial markers or a stereotactic computed tomography scan.…”

Section: Methodsmentioning

confidence: 99%

“…Emerging technologies have enabled increased operative efficiency for MRgLITT for SLAH. Ho et al 6 reported on utilizing a real-time MRI platform for completion of the entire procedure in the MRI suite. Rapid adoption of this new platform for MRgLITT was intuitive and led to decreased case times across the board, with preservation of accuracy and minimal learning curve.…”

Section: Mtlementioning

confidence: 99%

“…Placement of the laser probe within the intracranial space relies on varying methods of stereotaxy, but the use of real-time MRI stereotaxy has been shown to improve operative efficiency. 6 With decreased rates of perioperative and surgical morbidity, immediate radiographic visualization of the area being treated, and a less invasive target ablation, it is hoped that MRgLITT may increase the utilization of surgical therapies for medically intractable epilepsy.…”

Section: Introductionmentioning

confidence: 99%

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Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

Shukla¹,

Ho²,

Pendharkar³

et al. 2017

NDT

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Medically intractable epilepsy is associated with increased morbidity and mortality. For those with focal epilepsy and correlated electrophysiological or radiographic features, open surgical resection can achieve high rates of seizure control, but can be associated with neurologic deficits and cognitive effects. Recent innovations have allowed for more minimally invasive methods of surgical seizure control such as magnetic resonance-guided laser interstitial therapy (MRgLITT). MRgLITT achieves the goal of ablating seizure foci while preserving neuropsycho-logical function and offering real-time feedback and monitoring of tissue ablation. This review summarizes the utilization of MRgLITT for mesial temporal lobe epilepsy and other seizure disorders. Overall, the efficacy of MRgLITT is comparable to that of open surgery and offers a less invasive approach in patients with significantly less morbidity.

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Improved operative efficiency using a real-time MRI-guided stereotactic platform for laser amygdalohippocampotomy

Cited by 20 publications

References 19 publications

Stereotactic laser ablation for completion corpus callosotomy

Stereotactic laser ablation for completion corpus callosotomy

A Primer on Magnetic Resonance-Guided Laser Interstitial Thermal Therapy for Medically Refractory Epilepsy

Laser interstitial thermal therapy for the treatment of epilepsy: evidence to date

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